Diagnostic features & subtypes

• Onset within 3 months of identifiable stressor(s) and symptoms out of proportion to expected reaction or causing marked impairment.
• Symptoms resolve within 6 months after stressor or its consequences cease; if persist longer, reconsider other diagnoses.
• Subtypes: with depressed mood, with anxiety, mixed anxiety and depressed mood, with disturbance of conduct, or unspecified (other behavioural/emotional disturbances).

Common stressors & presentations

• Life transitions (divorce, retirement), bereavement, job loss, financial difficulties, medical diagnosis, relationship problems, relocation, or workplace stress.
• Presentations range from tearfulness and low mood, worry/insomnia, to behavioural issues such as aggression, impulsivity or social withdrawal affecting work/school.

Assessment checklist

1. Confirm timing: identify precipitating stressor(s) and document onset within 3 months.
2. Screen severity: impact on work, relationships, self‑care, suicidality, substance use and functional decline.
3. Rule out other disorders: major depressive disorder, PTSD, acute stress disorder, an anxiety disorder, bereavement and adjustment related to medical illness—use PHQ‑9, GAD‑7 and clinical interview.
4. Assess for risk: suicide, aggression, child/adult safeguarding concerns and substance misuse requiring urgent attention.

Management principles — stepped care

1. Brief psychosocial interventions: problem‑solving therapy, brief CBT, and behavioural activation are first‑line; these are effective and feasible in primary care.
2. Psychological First Aid & supportive counselling: for immediate post‑stressor period—validate reactions, provide practical support and connect to resources.
3. Stepped care: start low‑intensity interventions with monitoring; escalate to specialist therapy (CBT, IPT, trauma‑informed care) if poor response or complex comorbidity.
4. Address social determinants: involve occupational, social work, legal or financial services to resolve practical stressors where possible—this often accelerates recovery.

Brief therapies & practical techniques

• Problem‑Solving Therapy (PST): structured approach to define problems, generate solutions, choose and implement actions—effective for stress‑related adjustment problems.
• Brief CBT: cognitive restructuring, behavioural activation, activity scheduling, sleep hygiene and graded exposure to avoided situations.
• Motivational Interviewing: for cases with comorbid substance misuse or low engagement; helps set change goals and improve treatment adherence.

Pharmacotherapy — targeted use

• No medication is licensed specifically for adjustment disorder. Use short‑term pharmacotherapy to treat severe anxiety or depressive symptoms when needed (SSRIs for persistent low mood; short‑term hypnotics for sleep with caution).
• Avoid long‑term benzodiazepines; consider a clear, time‑limited plan with review if used for acute severe anxiety.

Practical tips for clinicians & workplaces

• Use a single clinician or case manager for ongoing follow‑up; provide written care plans and agreed review dates to limit fragmented care.
• For workplace cases, provide occupational adjustments (flexible hours, phased return), liaise with employer/HR with patient consent, and document recommendations for workplace accommodations.
• Provide self‑help resources (guided CBT workbooks, stress management apps) and signpost community supports (financial advice, legal aid, bereavement services).

Key takeaways

• Adjustment disorders are time‑linked stress responses causing disproportionate distress or functional impairment—recognise early and offer brief, targeted interventions.
• Problem‑solving, brief CBT and addressing social determinants are central; escalate for suicidality, severe impairment or persistent symptoms beyond 6 months.
• Coordinate care, use stepped approaches, and engage occupational/social services to address practical stressors that maintain distress.